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How do I diagnose DVT?

While management of patients with signs or symptoms of DVT may be shaped by local protocols and formularies, the NICE guidelines for venous thromboembolic diseases recommend an assessment of their general medical history and a physical examination to exclude other causes.1 For those in whom DVT is suspected, the following diagnostic pathway should be followed. As recommended in NICE Quality Standard [QS29], all diagnostic investigations should be completed within 24 hours of first clinical suspicion.2

Diagnosing venous thromboembolism in primary, secondary and tertiary care1

CDiagnosing-VT

An interactive version of the full NICE pathway for diagnosing VTE – including PE – is available here.1

Two-level DVT Wells score

The two-level DVT Wells score is a clinical prediction rule for estimating the probability of DVT and an important step in the diagnostic pathway. Patients who score 2 points or more are likely to have DVT and those with 1 point or less are unlikely.3,4 Click on the table to enlarge.

Clinical Model for Predicting the Pretest Probability of Deep-Vein Thrombosis4

Table Table

Anticoagulation

It is important that patients with suspected DVT are treated promptly to avoid adverse effects. NICE therefore recommends that patients should be offered interim anticoagulation therapy if diagnostic investigations are expected to take longer than 4 hours from the time of first clinical suspicion.2





In Managing VTE: Managing VTE | The signs and symptoms of VTE | Managing DVT | What information and support can I give to my patients?

Click here to view ELIQUIS prescribing and adverse event reporting information.

Abbreviations

DVT = Deep Vein Thrombosis NICE = National Institute for Health and Care Excellence VTE = Venous Thromboembolism

References
  1. NICE. Diagnosing venous thromboembolism in primary, secondary and tertiary care (NICE Pathways). 2018. Last accessed August 2019. Available at: https://pathways.nice.org.uk/pathways/venous-thromboembolism/diagnosing-venous-thromboembolism-in-primary-secondary-and-tertiary-care. Accessed August 2019.
  2. NICE. Quality Standard [QS29]. Venous thromboembolism in adults: diagnosis and management. Available at: https://www.nice.org.uk/guidance/qs29/chapter/List-of-quality-statements. Accessed August 2019.
  3. NICE. Venous thromboembolic diseases: diagnosis, management and thrombophilia testing (CG144). November 2015. Accessed August 2019.
  4. NICE clinical guideline 144. June 2012. Accessed August 2019. Available at: https://www.nice.org.uk/guidance/cg144/resources/twolevel-wells-score-templates-for-deep-vein-thrombosis-and-pulmonary-embolism-msword-186721165. Accessed August 2019.

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Job code: 432UK1900506-01
Date of preparation: September 2019

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